Values-Based Leadership in Healthcare

Congruent Leadership Explored

David Stanley

• Publisher: SAGE Publications Ltd
• Year: 2019
• ISBN:
  9781526489678
• Edition: 1
• Topic: Medicine
• Subtopic: Nursing

Stanley?s Values-Based Leadership in Healthcare proposes a bold new theory of leadership to help drive positive change in healthcare organisations. The theory of ?Congruent Leadership? is defined and presented through a series of corporate and clinical case studies and examples, which guide the reader through the possibilities for using their own values to inform best practice. Parallels are drawn between iconic historical figures and events, to show that healthcare professionalscan be courageous leaders by following their values and learning from great leaders past and present.

To aid understanding each chapter includes scenarios and reflective exercises to help readers grasp the application of theory to practice. By using an accessible frame of reference, Stanley outlines a refreshing alternative to existing theories of leadership and thoughtfully encourages practitioners to act in ethically-informed ways.

1 Leadership: What We Know Now

‘Leadership is practiced not so much in words as in attitude and in actions.’

Harold Geneen, CEO of ITT, Managing (1984)

Introduction

This book proposes a new way to understand and describe leadership within the healthcare domain as well as in the wider world. As such, this chapter starts by outlining what might already be known about leadership and leadership theories, and to do so thoroughly we will explore theories from across the academic spectrum, a theme that will continue throughout the book.

Understanding leadership is not a new phenomenon. It has been a feature of military and political agendas for many centuries. However, it is only in the last century or so that an understanding of leadership has become of interest to educational, business, industry and medical or health service organisations. This has occurred as the pace of change in industry and society has increased and the need to deal with people in more inclusive and collaborative ways has been recognised as vital for industrial and societal success. In my professional life, very little was mentioned of leadership (beyond discussions of management) until the 1990s and it was only then that my interest was sparked. There are a plethora of books, journal articles, web pages and papers that elaborate upon a wide variety of theories, definitions and perspectives about how to recognise effective leadership, develop better leaders, promote change or innovation and promote more effective organisations. While the origins of the theory presented in this book are from the health domain, this chapter will draw on concepts, definitions and theories of leadership from a far wider circle of literature including business, industry, educational and the military. This chapter aims to clarify what leadership means and explore how it may be understood.

Gaining an insight into leadership is fraught with obstacles and the concept of leadership can be a tricky one to capture. This partly explains why so much has been written about it from so many different perspectives and, surprisingly, why it remains generally understood so superficially. Commonly it has been linked to theories of management and associated with elevated hierarchical positions and power. This book is not specifically directed at leaders of this ilk, e.g. people in authority, managers or senior managers. However, there is a great deal this book will offer these leaders too. Indeed, leadership and leaders are considered to be different from management and managers (Zaleznik, 1977; Kotter, 1990; Stanley, 2006, 2011, 2017) and it is acknowledged that management and leadership functions and attributes are related to each other. For the purposes of this book, concepts of management are not explicitly explored or considered. This is a book about leadership, and it is for anyone who could be described as or aspire to become a leader.

Leadership Defined

Many people from a range of different groups have been interested in discovering more about leadership and for a long time the nature of leadership has been extensively considered and researched (Swanwick and McKimm, 2011). Chinese and Indian scholars have studied and written about leadership for centuries. It is referred to in the Old Testament and numerous mythical stories from civilisations across the globe address the act of leadership. The famous Chinese scholar Confucius wrote about leadership, and Plato, who lived between 427 and 347 BCE, wrote The Republic about the value of developing leadership characteristics by describing the attributes required to navigate and command at sea (Adair, 2002a). In almost any field or endeavour, from leading large corporations and massive armies, to leading the parents committee of a local school, in the hospital ward or office football team, leadership and the experience of being a leader is a common theme.

Definitions of leadership are everywhere. Stogdill (1974, p. 7) believes that ‘there are almost as many different definitions of leadership as there are people who have attempted to define the concept’. Northouse (2016, p. 2) too, indicates that as soon as ‘we try to define leadership, we immediately discover that leadership has many different meanings’. Research by Bennis and Nanus (1985, p. 4) had them suggest that in relation to leadership, ‘never have so many laboured so long to say so little’. I am almost apologetic for adding to the discussion. However, add to it I will although I hope to try and clarify leadership definitions and theories as we explore each of the theories. Understanding leadership in general is central to understanding the explanation of Congruent Leadership that follows and as such it is useful to begin with an exploration of the terms ‘leadership’ and ‘leader’.

There is a wide variety of definitions, beliefs and perspectives on the topic of leadership with Fiedler (1967), who primarily studied military and managerial leadership, suggesting that the leader has long been considered to be the individual in the group with the task of coordinating and directing the group’s activities. In the past, others have viewed leadership from a personality perspective, a power relationship perspective, as an instrument of goal achievement (Bass, 1990) or as part of a process of influencing people to accomplish goals (Northouse, 2016; Grossman and Valiga, 2013).

Leadership can also be viewed as achieving things with the support of others (Leigh and Maynard, 1995), and Wedderburn-Tate (1999, p. 107), writing from a healthcare perspective, feels that the leader’s function is to get others to ‘perform at consistently high levels, voluntarily’. This is in keeping with President Eisenhower’s view that leadership is the art of getting someone else to do something you want done because they want to do it (Stanton et al., 2010, p. 3). These definitions suggest that influence is an accepted factor in leadership.

Fiedler (1967) and Dublin (1968) suggest leadership addresses more than an influence and propose that leadership is the exercise of authority and the making of decisions. They see the leader as the person who has formal authority (power) and functional capacity over a group. Maxwell (2002), however, supporting Leigh and Maynard (1995) and Wedderburn-Tate (1999), feels this is going too far and that leadership is influence, nothing more, nothing less. Stogdill (1950), writing from the insights of his seminal work, also feels that leadership and influence are related, although he believes it may also be more than just this. He proposes another view, that leadership is the process of influencing people or the activities of a group to accomplish goals (Stogdill, 1950). This perspective supports the concept of influence and acknowledges that people without formal power can exercise leadership. Leadership is also seen as ‘a talent that each of us has and that can be learned, developed and nurtured. Most importantly it is not necessarily tied to a position of authority in an organisation’ (Grossman and Valiga, 2013, p. 18).

As well as goal-setting and influence, Stogdill (1950) suggests that leadership is also an important element in effecting change. Kotter (1990, p. 40), writing much later, supports this, indicating that ‘leadership is all about coping with change’. Bennis and Nanus (1985, p. 3) also understood that a leader is ‘one who commits people to action, who converts followers into leaders and who converts leaders into agents of change’. In addition, Lipman (1964, p. 122), defines leadership from a business/management perspective as ‘the initiation of a new structure or procedure for accomplishing an organisation’s goals and objectives’.

These views appear to suggest that change is central to leadership and they rest on the assumption that leaders function within an organisation where change, rather than stability, is the goal. Pedler et al. (2004), also writing from a management perspective, indicates that leadership – while including elements of the leader’s character and the context within which the leadership takes place – focuses on the critical tasks the leader must perform and the problems and challenges that leaders face, again, defining leadership by the leader’s ability to change or respond to challenges.

Leadership has been viewed as attending to the meanings and values of the group rather than just the authority, function, challenges and traits of the leader. Covey (1992) described what he called ‘principle-centred leadership’ and Pondy (1978) similarly proposed that the ability to make activities meaningful and not necessarily to change behaviour – but to give others a sense of understanding of what they are doing – is at the core of leadership. These perspectives fall close to those proposed around Congruent Leadership. Covey (1992) and Pondy (1978) suggest that the act of leading is about making the meaning of an activity explicit. ‘Unlike the supposed individualistic leadership of the past, now leadership is influenced by the impact of the immediate and surrounding context … the contention put forward is that (the) organisational context(s) provides the parameters within which current leadership is contained’ (Kakabadse and Kakabadse, 1999, p. 2). From this perspective it can be argued that the task of the leader is to interpret and clarify the context and thus provide a platform for communicating meaning within the activity.

As a result, leadership becomes more about selecting, synthesising and articulating an appropriate vision for the follower (Bennis et al., 1995). Greenfield (1986) also explored the concept of vision by suggesting that, rather than just clarifying the meaning or making the activity meaningful, leadership is about setting the meaning, describing leadership as ‘a wilful act where one person attempts to construct the social world for others … leaders will try to commit others to the values that they themselves believe are good and that organisations are built on the unification of people around values’ (Greenfield, 1986, p. 166). Bell and Ritchie (1999) and Day et al. (2000), like Greenfield (1986), writing from an education perspective, commonly refer to the ‘head teacher’ as the person within a school who is responsible for ‘establishing core characteristics’ (Bell and Ritchie, 1999, p. 24) and for committing others to their values and setting the overall aims for the school.

However, no one definition can be considered wholly right or wrong and there are a multitude of other perspectives that have not been outlined above. There is considerable overlap and blurring at the edges too and these varied perspectives and definitions, while offering an eclectic view of leadership, may sit more comfortably alongside Duke’s (1986, p. 10) suggestion that ‘leadership seems to be a Gestalt phenomenon, greater than the sum of its parts.’

Therefore it is evident that leadership has been studied in many fields of endeavour, by many scholars and individuals for a very long time. However, rather than resulting in a clear and unequivocal understanding of leadership, many different and sometimes opposing definitions have evolved and exist (Swanwick and McKimm, 2011; Jones and Bennett, 2012; Rigolosi, 2013). These varied definitions could easily lead to confusion or unsettle the concept of leadership. Instead, I feel these definitions function like the dishes at a banquet, with each individual dish adding to the glory of the collective whole and each dish offering something that helps explain what leadership is and how leadership can be understood.

However, definitions alone offer only a taste of the meaning of leadership. A wider view may be more helpful. To this end, the next section explores the theoretical perspectives of leadership and brings a greater array of dishes to the banquet.

Theories and Styles

In order to further clarify information about leadership and leaders, it is prudent to explore the theories and concepts of leadership that are prominent in the literature. The theories and styles of leadership are not proposed in a linear way, although the later theories have grown from, or are at least a reaction to, earlier theories. The following pages offer only an introduction to leadership theories, but it is hoped they set the stage for a consideration of Congruent Leadership theory and an understanding of leadership in the wider context of this book.

The Great Man Theory: Born to Lead

The ‘Great Man Theory’ (Galton, 1869, cited in Morrison, 1993) is one of the earliest theories of leadership. It suggests that leadership is a matter of birth, with the characteristics of leadership being inherited or, as Man (2010) suggests, assigned by divine decree. Bennis and Nanus (1985, p. 5) explained this theory by saying ‘those of the right breed could lead; all others must be led.’ This theory is about individuals born into ‘great’ families being considered to be infused with the skills and characteristics of a leader. The Great Man Theory is the seat of a very old view of leadership, where monarchist ideals and a belief in the line of succession dominate.

The Big Bang Theory: Great Events Make Great Leaders

The ‘Big Bang Theory’ proposed that calamitous circumstances provided the elements essential for the creation of leaders. Leaders, it suggests, were created by the great events that affected their lives (Grossman and Valiga, 2013). Here, the revolutions of the nineteenth and twentieth centuries and First World War are cited as examples of major calamitous circumstances, but this type of event could as easily be international or local terror events, such as the Lindt coffee shop siege in Sydney, or the Paris and London terror atrocities, or a natural disaster such as the Australian floods in 2011 and the Victorian fires in 2009 and 2015. The calamitous event could as easily be a family crisis or a personal catastrophe, such as the one that befell Malala Yousafzai in Pakistan and thrust leadership responsibilities onto her (see Chapter 7). Bennis and Nanus (1985, p. 5) explain this theory by saying that ‘great events made leaders of otherwise ordinary people.’ This suggests that it was the situation and the followers that combined to create the leader.

The lives of a number of great political and military leaders might be used to substantiate this theory of leadership. The life and rise to power of Napoleon Bonaparte following the after-effects of the French Revolution or the activism of Lech Walesa after martial law was imposed in Poland in the 1970s offer two examples of this theory in practice. The theory that otherwise ordinary people become great leaders because of great events may be true for some leaders but, as with Bonaparte or Walesa, much of this leader’s success may be attributable to their hard work, courage and knowledge in preparation for the great events that unfold in their lifetime.

Trait Theory: Attributes Are All

Another theory is the ‘Trait Theory’ of leadership. This theory rests on the assumption that the individual is more important than the situation. Thus it was proposed that the identification of distinguishing characteristics of successful leaders would give clues about leadership (Swanwick and McKimm, 2011; Grossman and Valiga, 2013). Rafferty (1993) and Jones and Bennett (2012) refer to this as the constitutional approach, where part of the assumption is that if great leaders cannot be trained or taught, they can at least be selected, linking this with attributes of the Great Man Theory.

A large number of studies in the early part of the twentieth century (Stogdill, 1948, 1974; Yoder-Wise, 2015; Mann, 1959; Kirkpatrick and Locke, 1991; Smith, 1999; Grossman and Valiga, 2013; Northouse, 2016) were initiated to consider the traits of the great leaders. However, as Bass (1990) indicates, while a number of traits did seem to correspond with leadership, no qualities were found that were universal to all leaders. Stogdill (1948), who undertook a major review of universal leadership traits between ...

Table of contents

• Cover
• Half Title
• Publisher Note
• Title Page
• Copyright Page
• Contents
• About the Author
• Foreword
• Preface
• Acknowledgements
• Publisher’s Acknowledgements
• Leadership Background
• 1 Leadership: What We Know Now
• Congruent Leadership Outlined
• 2 Congruent Leadership Theory
• 3 Attributes of Congruent Leaders
• 4 Vision versus Values
• 5 The Strengths and Limitations of Congruent Leadership
• The Context Of Congruent Leadership
• 6 The Power of Self
• 7 Organisational Culture and Congruent Leadership
• 8 The Application of Congruent Leadership in the Workplace
• 9 Summary: The Congruent Leader
• References
• Index